We report a case of new-onset atrial fibrillation with rapid ventricular response in a 37-year-old malewho presented to the emergency department. This patient was not admitted to the hospital or placed onobservation, but rather placed on a cellular outpatient 12-lead telemetry (COTLT) device with emergencyresponse capabilities and discharged home. We define a new modality that allows these patients tobe managed via telemedicine and receive care similar to that which would be rendered in a hospital orobservation unit.